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Trying To Find The Cost Of A Medical Procedure? Good Luck

BOSTON — As soon as Gov. Deval Patrick signs it, which he’s said he’ll do soon, a sweeping plan to hold down health care costs in Massachusetts will become law. It’s partly designed to get patients to help drive down prices by shopping for the best medical care. By chance, WBUR reporter Martha Bebinger, who covers health care, needs an MRI this week to try to figure out why she’s been having migraines lately. As she scheduled that scan, she learned first-hand that even though this new state plan says health care providers will soon have to make price information readily accessible to patients, we’re a long way from that. Martha spoke with WBUR’s All Things Considered host Sacha Pfeiffer to explain.

Sacha Pfeiffer: Martha, first, I’m very sorry to hear about your headaches, and I hope they go away soon.

Martha Bebinger: Thanks. I do have some conflicting feelings about whether I should get an MRI. It’s a very expensive test, and maybe the headaches will just disappear. But my doctor is recommending it, so I’m going ahead.

You’re following doctor’s orders. So it’s expensive, as you said, and you tried to find out in advance how much your MRI would cost. How did that process go?

Well, I started at Newton-Wellesley Hospital, which is where my doctor sent me, and it’s been six hours since I first started making calls and I don’t have an answer yet. My doctor didn’t know, I got transferred to radiology, I got transferred to billing. Billing said they would call me back. I’ve called them back three times now and I just get a machine.

You couldn’t even get a ballpark estimate?

I couldn’t get a ballpark.

Now you do have insurance, we should clarify, through your job.

I do. I have insurance with no deductible, so wherever I go this is going to cost me $25. Sorry to all of you with high-deductible or tiered plans out there. But I thought, ‘You know, I’ll try to be an engaged patient.’ I mean, they’re telling me this is what I’m supposed to be doing, so I’ll start looking for the price. So when I couldn’t get through to Newton Wellesley, I tried Mass General, which is what we usually hear is the most expensive, best place, best hospital in the country to go to. They were $5,315, I think. That’s for an uninsured patient.

For one MRI — five grand?

For one MRI. Because they couldn’t tell me what my rate was going to be as an insured patient. They said they didn’t have that information.

That’s kind of like the private-pay equivalent?

Yeah. If you don’t have any insurance at all and you walk in the door, that’s the bill they’re going to eventually send you. They said, ‘Call your insurer.’ I called my insurer. My insurer said, ‘We don’t have that information, either.’ So I’m kind of hitting a wall. So I call Shields, which is an independent lab. They were $600 for the MRI without the dye, and $1,200 for the MRI with the dye.

Does that change depending on whether you have insurance?

Yes. They could, for some reason — I don’t know why, Sacha — they could give me the rate with insurance, with my HMO Blue Cross plan.

So one place, MGH, tells you $5,000. Shields tells you $600. Massive disparity.

Yeah.

Overall, how difficult would you say it has been for you to try to find this price?

I can’t imagine anyone doing this, Sacha. I was on the phone or on hold for two hours. Very nice people, and this is new. I mean, the bill is not law yet. This requirement does not exist. It will be several years before it’s starting to happen. But we’re hearing so much that this is going to be an answer to high prices, and so I’m thinking, really? I mean, you can’t get them.

And this is a key piece of state health care reform, because we want patients to be able to be knowledgeable and informed — and even you, who covers this industry, can’t get these numbers.

I can’t find them.

You spoke this morning to Gene Lindsey. He’s a doctor who runs Atrius, the state’s largest physicians group. It includes Harvard Vanguard. Let’s hear what he said to you about how far we are in Massachusetts from the day when patients can go to their doctor, get a referral for a test or procedure, and right away look at the price and quality options:

Gene Lindsey: We’re a long way from it, but now that we’ve been given the goal and the charge, I can tell you that Atrius Health will, in a very, very focused way, begin the work that’s necessary to try to deliver what the bill asks for in terms of cost transparency.”

So Martha, where is Atrius starting?

Atrius and a few other physicians groups have started putting some price information in the record that doctors can see when they are speaking to a patient, for things like lab tests or the MRIs and such that I’m trying to get a price for. They’re a long way from being able to say, ‘You’re going in for an appendectomy and here’s what it’s going to cost,’ because there are so many variables when you go into a hospital for a procedure. But Atrius — they’re just starting to shop for software that’ll pull all the information like my health insurance data together so that they can say, ‘OK, oh, you’re an HMO patient, here’s what you’ll pay’ or, ‘You have a high deductible, here’s what you’ll pay.’

Martha, since you’re someone who covers health care, what advice do you have for listeners and other patients who want to try to be smart health care shoppers?

One really practical piece of advice: Get the code. So my MRI code? 70551 without the dye, 70552 with the dye. That’s a number I had to drill into my head today to be sure I kept giving it. So that’s the very practical advice. Then the broader advice is: If you really have to pay attention to price because you have a high-deductible or high-tiered plan, then do a lot of deep breathing. Just be ready for a long struggle that will take some patience.

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  • rfra20

    This isn’t news, this is one of the main problems in the health care system.  It’s a racket.  What’s the difference with the mob – really I’m not kidding.  Yeah Joey that “procedure” is gonna cost ya $5K.  Oh wait – you been payin Guido that protection money I see – well we can work out a deal for you then….

  • John Yoder

    This is one of the things wrong with the insurance system and you can see how it started.  It started about 50 years ago when everyone started to be covered by insurance (really pre-paid health care).  Costs were paid by a third party.  Even things that people could afford e.g. birth control pills, were covered.  There was a middleman.   There was no competition on price.  I don’t see price competition returning soon.  This is also true for the new “affordable health care act”.  It will not be affordable unless people start taking responsibility for routine health care costs and price competition is restored.  We have a very innovative business community and costs for routine care could be greatly reduced if it were allowed.  Now however, we go to the hospital/clinic and pay no attention to the prices.  I don’t see changes coming. 

  • Elizabeth

    I had a similar experience. We were expecting a baby early in the year and had a high-deductible plan, so we needed to budget for the L&D expenses. I couldn’t get answer about how much it would cost. I was told $10,000 – $30,000, depending on what procedures I needed and whether or not I needed/wanted an epidural. Mid-way through pregnancy I was surprised with a $2000 bill to cover routine bloodwork. Then I tried to find out how much the remaining pregnancy-related care would cost and couldn’t get a price. Actually got treated very rudely by the doctor’s office and hospital when I kept calling and requesting these numbers. I ended up choosing a midwife so that L&D would costs less with no anesthesia. And left the hospital after one day to save another $1500 – $2000 for the cost of a room.

  • payer

    Similar situation – when I didn’t have dental insurance I had an extraction.  I was charged $500.  Later, when I did have dental insurance, which I paid a bi-weekly rate pretax, I was charged $600 on top of paying for the insurance.  This is with the same dental provider.

    So, regardless of whether you know what your provider is charging, you need to know your insurance payment rates. 

    I can’t imagine insurance fee schedules should be that hard to get your hands on.  This is the real bottom line amidst this confusion.

  • Affordablehealthcare

    This is why high deductible plans are a joke. People need to start looking into accountable care organizations and health care systems promoting affordable health care if they want the cost of care to decrease. It may limit the amount of providers you are able to see, but quality of care is not the problem in MA (having access to all providers is equal to overinsurance). Cost is the problem. Choosing your health care system, based on quality and cost, will become the most important factor for those interested in affordable health care.  

  • Broke patient

    I had very similar situation after experiencing vertigo. This was at my primary office at Brigham & Women’s Boston when I was told I needed to have an MRI & MRA (with die). I told the doctor that ordered it that I really wanted to make an appointment at the MRI place in Dedham because they had an “Open MRI” and that I had an MRI/MRA there years ago.  She said, no, I would prefer you had it in B & W’s, because the imaging on the open is not as good as the B & W’s.  So I did what the doctor ordered.  Well what they neglected to tell me is that if you have an MRI or and MRA at B & W, in addition to you paying your deductible (mine being $2,000/year) you would be required to pay an ADDITIONAL $450 charge per MRI because you had it done at this high tier hospital, who charges so much more.  When I got the bill, the $4,000 and with the reading charges the bill totalled ~$15K, I was outraged.  I called BCBS and told them I had 1 MRI/MRA.  I was in 1 machine once for a total of 45 minutes.  The table was never moved out of the MRI machine at all.  They injected the die at the end while I was still in the machine. So it was one test, not three.  Well BCBS gives me an outrageous co-pay on all 3.  However, they rejected one of the 3 charges because they stated B & W did the same test twice on one day, but they expected me to pay my fair share, although they rejected all of it.  WHAT??? After my challenging that it’s one test and I never moved out of the machine, so what the Heck!!!  I am have brought it up to my Dr. who suggested I deal with the Radiology dept.  I also don’t understand why BCBS paid them so much on two of the line items.  They also charged to read the imaging twice….MRI and MRI.  This truly stinks, I cannot afford to pay such outrageous charges especially when I am paying upwards of $700/mo. and carry a $2K decuctible.

    • http://www.wbur.org/people/martha-bebinger Martha Bebinger

      Hi Broke Patient – great story – will you please post any updates you want to share here: healthcaresavvy.wbur.org?

      Thanks!

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